The Future for Flint’s Children

Flint, Mich. — THE World Health Organization’s “action level” for lead contamination in drinking water — indicating the need for intervention — is 10 parts per billion. The Environmental Protection Agency’s action level is 15 parts per billion.

In tests of tap water in Flint., Mich., over the last six months, some 1,300 homes exceeded the E.P.A. action level. Thirty-two had levels above 1,000 parts per billion. And just this month, a sample showed a concentration as high as 11,846 parts per billion.

To understand the contamination of this city, think about drinking water through a straw coated in lead. As you sip, lead particles flake off into the water and are ingested. For almost two years, Flint’s children have been drinking water through lead-coated straws.

There are so many things wrong with this that it’s difficult to know what to address first. But since I called attention last year to an increase in children with elevated lead levels after the city changed its water supply, I’ve known that my focus had to be on the kids. One of my patients, a 2-year-old girl, recently came to the clinic for her checkup. Running around the room with her colorful gown flapping, she hopped onto the exam table, grabbed my stethoscope and placed it on her chest. I gently nudged it over her heart. “Can you hear anything?” Her eyes lit up, and she nodded.

Her mother turned to me, trying to hide her tears. She thought the water was safe, and why not? The authorities told her it was. She mixed her daughter’s baby formula with warm tap water. She got a filter only when the National Guard came to her door this year. Now she wonders, will her daughter be O.K.?

Photo

Dr. Mona Hanna-Attisha examines a patient at Hurley Children’s Center in Flint, Mich.Credit
Laura McDermott for The New York Times

The same question can be asked about the more than 8,000 other children here under the age of 6 who drank lead-contaminated water.

Numerous epidemiologic studies of lead exposure in children, particularly those under the age of 6, indicate an increased risk for damage to cognition, behavior and employment prospects, also lower I.Q.s, poor impulse control and decreased lifetime earnings. Epigenetic research suggests that lead exposure in women can lead to DNA changes in their grandchildren. Their grandchildren.

And yet my little patient may be all right. Not every child exposed to lead will suffer the most severe consequences. Some will be fine, though the Centers for Disease Control and Prevention warns that there is no safe level of lead in a child.

Families here are traumatized; faith and trust in government have evaporated. State and federal agencies responsible for protecting them failed miserably. Much has been written about the roots of the Flint water crisis: misguided fiscal austerity, inequality, racism, environmental injustice, poverty, deindustrialization. These are all important and nationally relevant issues, but the focus now needs to turn to the future, and to healing.

We cannot wait to see the potential cognitive and behavioral consequences; we must act. Developmental neurobiology has taught us that adverse childhood experiences and toxic stress change the trajectory of a child’s life in predictable ways.

But science also gives us hope. We can reduce the impact of these adversities, including lead exposure, when we wrap these children in evidence-based interventions to promote their development. These include maternal infant support and early literacy programs; universal preschool; school health services; nutrition programs; and primary medical care and mental health care. All vulnerable children need these interventions, but kids in Flint need them now, not next month or next year.

At the Pediatric Public Health Initiative, created by Michigan State University and Hurley Children’s Hospital in response to this crisis, we are aiming to help Flint not only recover, but thrive. Flint is proud and resilient (it helped put America on wheels), but we can’t do this alone.

Unfortunately, not enough money has been allocated for the long-term child development initiatives we need. Gov. Rick Snyder recently proposed a budget that would spend $195 million on the lead problem here, including $63 million for health-related programs and $15 million for food and nutrition initiatives. I am hopeful that the State Legislature will enact these measures. But even this support would not address the full magnitude of this problem, which will continue throughout these children’s lives. We must make a yearslong commitment.

We also need federal help, and much more than the $220 million Congress is considering for water infrastructure and health-related services to communities nationwide. This is not a partisan issue; it is a humanitarian one.

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Some will say we can’t afford it. But our nation has never been reluctant to aid victims of hurricanes, tornadoes, floods or earthquakes. Shortsighted cost-cutting and willful bureaucratic blindness may have caused the calamity in Flint but the effect is no less than a huge natural disaster.

When I turn back to my patient’s mother, I give her a hug. I remind her to keep using the water filter, give her daughter great nutrition, sign her up for preschool, read to her, sing to her, love her and be there for her. Her daughter has been exposed to lead-contaminated water for almost her entire life, during her most critical brain development. I don’t have a magic pill that can take that away, but I do have a prescription for hope.

As she reaches for my stethoscope again, I tell her mom that she is going to be O.K. No, she’ll be great. With the nation’s help, we will heal. Because we are not a nation that can accept 11,846 parts per billion of lead in drinking water. Or the consequences for the children of Flint.

Mona Hanna-Attisha is a pediatrician at Hurley Children’s Hospital and an assistant professor at Michigan State University’s College of Human Medicine.